ACKNOWLEDGMENT SLIP ( Please retain this slip)
Request for: Registration of Sip Registration of Sip Insure Registration of Micro Sip
Name of the Investor Mr/Ms/M/s :
Scheme /Plan/ Option:
Payment Details:
Amount
`
Instrument No/Cash Deposit Slip No. Date : Drawn on Bank
Time Stamp & Date
of receiving office
Application No.:
ONE TIME BANK MANDATE
(NACH / Direct Debit Mandate Form)
(Applicable for Lumpsum Additional Purchases as well as SIP Registration)
With Bank __________________________________________________________
an amount of Rupees _________________________________________________________________________________
Email ID: ______________________________________________________________________
Mobile / Phone No: _____________________________________________________________
I agree for the debit of mandate processing charges by the bank whom I am authorizing to debit my account as per latest schedule of charges of the bank.
This is to confirm that the declaration (as mentioned overleaf) has been carefully read, understood & made by me / us. I am authorizing the User Entity / Corporate to debit my account, based on the instructions as agreed and signed by me.
I have understood that I am authorized to cancel / amend this mandate by appropriately communicating the cancellation / amendment request to the User entity / Corporate or the bank where I have authorized the debit.
Reference 1
Reference 2
Folio No.
Appln No.
FREQUENCY:
Monthly Quarterly Half Yearly Yearly as & when presented DEBIT TYPE Fixed Amount Maximum Amount
x
x x xx
PERIOD
From :
To:
Or Until Cancelled
3 1 1 2 2 0 9 9
D D M M Y Y Y Y
D D M M Y Y Y Y
(Name of Destination Bank)
(For Office Use Only)
UMRN
(For Office Use Only)
Sponsor Bank Code ______________________________ Utility Code _________________________________ Date:
Nippon India Mutual Fund
(Destination Bank Account Number)
I/We hereby authorize _____________________________
Bank A/c no:
Modify
Create
x
x
Cancel
to debit (tick ) SB CA CC SB-NRE SB-NRO Other
`
MICR
IFSC
APP No.
D D M M Y Y Y Y
Signature of Account Holder
Name as in Bank Record
1 ___________________________
1 ___________________________
Name as in Bank Record
Signature of Account Holder
2 ___________________________
2 ___________________________
Name as in Bank Record
Signature of Account Holder
3 ___________________________
3 ___________________________
Third Applicant /
Authorised Signatory
First / Sole Applicant / Guardian /
Authorised Signatory
Second Applicant /
Authorised Signatory
SIGN
HERE
Upfront commission shall be paid directly by the investor to the AMFI registered distributor based on the investor's assessment of various factors including the service rendered by the distributor.
*Please sign alongside in case the EUIN is left blank/not provided. I/We hereby confirm that the EUIN box has been intentionally left blank by me/us as this transaction is executed without any interaction or advice by the
employee/relationship manager/sales person of the above distributor/sub broker or notwithstanding the advice of in-appropriateness, if any, provided by the employee/relationship manager/sales person of the distributor/sub broker.
Name & Broker Code / ARN Sub Agent CodeSub Agent ARN Code
*Employee Unique Identification Number
++
RIA Code
ARN-
(ARN stamp here)
ARN-
DISTRIBUTOR / BROKER INFORMATION
(Refer Instruction No. 12 & 13)
DECLARATION AND SIGNATURE
++ I/We, have invested in the Scheme(s) of your Mutual Fund under Direct Plan. I/We hereby give you my/our consent to share/provide the transactions data feed/ portfolio holdings/ NAV etc. in respect of my/our investments under Direct
Plan of all Schemes Managed by you, to the above mentioned Mutual Fund Distributor / SEBI-Registered Investment Adviser. I hereby authorize the representatives of Reliance Nippon Life Asset Management Ltd and its Associates to
contact me through any mode of communication. This will override registry on DND / DNDC , as the case may be.
I have read and hereby confirm Instruction no. XIII(A) and also hereby agree to abide by Instruction no. XIII(B). I hereby declare that the information provided in the Form is in accordance with section 285BA of the Income Tax Act, 1961 read
with Rules 114F to 114H of the Income Tax Rules, 1962 and the information provided by me /us in the Form, its supporting Annexures as well as in the documentary evidence provided by me/us are, to the best of our knowledge and belief,
true, correct and complete.I understand that the insurance claim and the payment of the sum insured shall be made directly by Reliance Nippon Life Insurance Company Ltd (RNLIC) subject to the terms and conditions of insurance, read along
with the Certificate of Insurance of the group term insurance policy, Scheme Information Document and Statement of Additional Information. In the event my nominee is minor at the time of claim, I authorise RNLIC to make the payment only
on collection of lawful guardian details under the policy. Signed at_________________________________on this__________________________day of_______________20________.
I/We would like to invest in Nippon India ______________________________________________ subject to terms of the Statement of Additional Information (SAI) and Scheme Information Document (SID) and subsequent amendments thereto.
I/We have read, understood (before filling application form) and is/are bound to the details of the SAI and SID including details relating to various services including but not limited to ATM/ Debit Card. I/We have not received nor been
induced by any rebate or gifts, directly or indirectly, in making this investment. I accept and agree to be bound by the said Terms and Conditions including those excluding/ limiting the Reliance Nippon Life Asset Management Limited liability. I
understand that the RNAM may, at its absolute discretion, discontinue any of the services completely or partially without any prior notice to me. I agree RNAM can debit from my folio for the service charges as applicable from time to time.
The ARN holder has disclosed to me/us all the commissions (in the form of trail commission or any other mode), payable to him for the different competing Schemes of various Mutual Funds from amongst which the Scheme is being
recommended to me/us. I hereby declare that the above information is
given by the undersigned and particulars given by me/us are correct and complete. Further, I agree that the transaction charge (if applicable) shall be deducted from the
subscription amount and the said charges shall be paid to the distributors. I confirm that I am resident of India. I/We confirm that I am/We are Non-Resident of Indian Nationality/Origin and I/We hereby confirm that the funds for
subscription have been remitted from abroad through normal banking channels or from funds in my/our Non-Resident External /Ordinary Account/FCNR Account. I/We undertake that all additional purchases made under this folio will also
be from funds received from abroad through approved banking channels or from funds in my/ our NRE/FCNR Account.
By signing this SIP enrolment form I/We understand that the amount will be debited from the Bank account mentioned in One Time Bank Mandate / Invest Easy - Individuals Mandate Form.
Third Applicant /
Authorised Signatory
First / Sole Applicant / Guardian /
Authorised Signatory
Second Applicant /
Authorised Signatory
SIGN
HERE
Investors are requested to note that the amount mentioned in One Time Bank Mandate should be the maximum amount that you would like to invest in schemes of NIMF on any transaction day.
** In case of Nippon India Tax Saver Fund, Nippon India Retirement fund - Income Generation Plan & Nippon India Retirement fund- Wealth Creation Plan, the Step up minimum Amount should be ` 500 and in multiples of ` 500/- .
$ Incase the SIP ‘End Date’ is incorrect/ not legible/ not mentioned by the investor, then default end date shall be considered as December 2099. Note: STEP-UP facility is not applicable for SIP Insure registrations.
SIP DETAILS Refer Instruction No. 13. Please refer respective SID/KIM for product labeling. Refer SIP Insure instructions in case you have opted for SIP Insure.
Step-Up Facility (Optional) (Refer Instruction No. 25)
Count
Increase SIP amount
time(s)
(Default 1 time)
Frequency
Amount
`
**
(Multiples of 100 only )
`
Yearly (Default)
Half-yearly
`
(in figures)
Scheme / Plan / Option
SIP
Amount
st
(Any date from 1 to
th
28 of a given month)
D D
SIP Date
M M
Y
Y Y Y
M M
Y
Y Y Y
From
$
To
Quarterly Yearly
Monthly
(Default)
Enrollment Period
Frequency
(Please any one)
INITIAL INVESTMENT DETAILS
Bank Name:
Cheque/ DD No./Cash Deposit Slip No. Cheque / DD / Cash Deposition Date
Branch: City:
Net Amount
`
DD Charge
`
REQUEST FOR Registration of SIP$ Registration of SIP Insure Registration of Micro SIP
$
( Default option if not selected)
APPLICANT DETAILS
Name of Sole/1st holder
Name of 2nd holder
Name of 3rd holder
Mr./Ms./M/s
Mr./Ms.
Mr./Ms.
FOLIO NO.
KYC
KYC
KYC
PAN No / PEKRN.
PAN No / PEKRN.
PAN No / PEKRN.
M A N D A T O R Y
M A N D A T O R Y
M A N D A T O R Y
UNITHOLDING OPTION -
Demat Mode Physical Mode
(Ref. Instruction No. 23) Demat Account details are compulsory if demat mode is opted. Not applicable if you have opted for SIP Insure.
Target ID No.
DP ID No. Beneficiary Account No.
I N
National Securities Depository Limited (NSDL) Central Depository Securities Limited (CDSL)
Enclosures (Please tick any one box) : Client Master List (CML) Transaction cum Holding Statement Cancelled Delivery Instruction Slip (DIS)
(Nomination is mandatory if you have opted for SIP Insure) (Refer Instruction No. 26 to 29 ) In case of existing investor, nomination details mentioned
in the below table will replace the existing details registered in the folio. Signature of applicants is mandatory if you do not wish to nominate.
NOMINATION - I wish to Nominate
Nominee Name & Address
Guardian Name
(in case Nominee is Minor)
Guardian Relation
with Nominee
Allocation
(%)
Sign of
Nominee
Sign of
Guardian
Signature of Applicants
1st Applicant
2nd Applicant
3rd Applicant
Date of Birth
of Nominee
Nominee Relation
With Investor
PAN of Nominee
(Optional)
Yes No
SIP / SIP INSURE ENROLLMENT DETAILS
APP No.:
One Time Bank Mandate + SIP & SIP Insure Enrollment Form / 24th Oct 2019 / Ver 1.9
QFund.in Mutual Fund India
Mutual Fund India
Mutual Fund India
Bandra West
Mutual Fund INdia
Mutual Fund India
Mutual Fund India
Mutual fund India
Mutual Fund India
Mutual Fund Mumbai
Qfund
Mutual Fund India
Mumbai
Mutual Fund India
QFund.in
Mutual Fund Mumbai
Mutual Fund Mumbai
mutual fund Mumbai
Mutual fund
mumbai
Authorisation to Bank: I/We wish to inform you that I/we have registered with Nippon India Mutual Fund for NACH / Direct Debit through their authorised Service Provider(s) and representative for my/our payment
to the above mentioned beneficiary by debit to my/our above mentioned bank account. For this purpose I/We hereby approve to raise a debit to my/our above mentioned account with your branch. I/We hereby
authorize you to honor all such requests received through to debit my/our account with the amount requested, for due remittance of the proceeds to the beneficiary.
THIS SECTION IS INTENTIONALLY KEPT BLANK
FOR OFFICE USE ONLY (Not to be filled in by Investor)
Affix Barcode
Date and Time Stamp No.
One Time Bank Mandate + SIP & SIP Insure Enrollment Form / 24th Oct 2019 / Ver 1.9
Mutual Fund Mumbai
Mutual Fund Mumbai